Wash. Admin. Code § 296-20-12401

Current through Register Vol. 25-01, January 1, 2025

Section 296-20-12401 - Application process for providers outside the scope of the provider network

For providers or services not subject to the health care provider network requirements, including treatment at the initial office or emergency room visit, a provider must obtain a provider account number from the department.

(1)How can a provider obtain a provider account number from the department? In order to receive a provider account number from the department, a provider must:

Complete a provider application;

Sign a provider agreement;

Provide a copy of any practice or other license held;

Complete, sign and return a Form W-9; and

Meet the department's provider eligibility requirements as cited in the department's rules.

Notes:	A provider account number is required to receive payment from the department, but is not a guarantee of payment for services.
Self-insured employers may have additional requirements for provider status.

(2)Provider account status definitions.

Active - Account information is current and provider is eligible to receive payment.

Inactive - Account is not eligible to receive payment based on action by the department or at provider request. These accounts can be reactivated.

Terminated - Account is not eligible to receive payment based on action by the department or at provider request. These accounts can not be reactivated.

(3)When may the department inactivate a provider account? The department may inactivate a provider account when:

There has been no billing activity on the account for eighteen months; or

The provider requests inactivation; or

Provider communications are returned due to address changes; or

The department changes the provider application or application procedures; or

Provider does not comply with department request to update information.

(4)When may the department terminate a provider account? The department may terminate a provider account when:

The provider is found ineligible to treat per department rules; or

The provider requests termination; or

The provider dies or is no longer in active business status.

(5)How can a provider reactivate a provider account? To reactivate a provider account, the provider may call or write the department. The department may require the provider to update the provider application and/or agreement or complete other needed forms prior to reactivation. Account reactivation is subject to department review.

If a provider account has been terminated, a new provider application will be required.

Wash. Admin. Code § 296-20-12401

Statutory Authority: RCW 51.36.010, 51.04.020, and 51.04.030. 12-06-066, § 296-20-12401, filed 3/6/12, effective 4/6/12. Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080. 00-09-078, § 296-20-12401, filed 4/18/00, effective 7/1/00.